Agenda and minutes

Members of the Committee introduced themselves to those present at the meeting

Councillor Janet Burgess, Executive Member Health and Wellbeing, Councillor Kaya Comer Shwartz and Fiona McKenzie, Governor UCLH

Councillor Nicholls stated that he was substituting for Councillor Comer Schwartz

If you have a Disclosable Pecuniary Interest* in an item of business:

§  if it is not yet on the council’s register, you must declare both the existence and details of it at the start of the meeting or when it becomes apparent;

§  you may choose to declare a Disclosable Pecuniary Interest that is already in the register in the interests of openness and transparency. 

In both the above cases, you must leave the room without participating in discussion of the item.

If you have a personal interest in an item of business and you intend to speak or vote on the item you must declare both the existence and details of it at the start of the meeting or when it becomes apparent but you may participate in the discussion and vote on the item.

*(a)Employment, etc - Any employment, office, trade, profession or vocation carried on for profit or gain.

 (b)Sponsorship - Any payment or other financial benefit in respect of your expenses in carrying out

  duties as a member, or of your election; including from a trade union.

 (c)Contracts - Any current contract for goods, services or works, between you or your partner (or a body

 in which one of you has a beneficial interest) and the council.

 (d)Land - Any beneficial interest in land which is within the council’s area.

 (e)Licences- Any licence to occupy land in the council’s area for a month or longer.

 (f)Corporate tenancies - Any tenancy between the council and a body in which you or your partner have

  a beneficial interest.

 (g)Securities - Any beneficial interest in securities of a body which has a place of business or land in the council’s area, if the total nominal value of the securities exceeds £25,000 or one hundredth of the total issued share capital of that body or of any one class of its issued share capital. 

This applies to all members present at the meeting.

None

The Chair stated that the order of business would be as per the agenda

RESOLVED:

That the minutes of the meeting of the Committee held on 13 January 2015 be confirmed and the Chair be authorised to sign them

None

The Chair outlined the procedure for Public questions and the filming and recording of meetings

The Chair will update the Committee on recent events.

The Chair stated that there had been concern expressed recently in the media about the number of people being referred to Accident and Emergency and GP’s through the 111 system and this was an area that may need to be looked at in the future

Councillor Janet Burgess, Executive Member Health and Wellbeing was unable to be present and the Chair stated that the update on the work of the Health and Wellbeing Board would be considered at the next meeting

Alison Blair, Chief Officer Islington CCG,  Dr.David Davies, GP and clinical lead for the NHS 111 and out of hours re-procurement, Islington CCG, Samit Shah, Clinical lead for the NHS 111 and out of hours re-procurement for North Central London CCG’s. Rebecca Kingsnorth, Head of Service Transformation, Islington CCG and Dr.Robbie Bunt, GP and Chair of the Local Medical Committee.

The Chair had also invited Dr. Nick Mann, a Hackney GP to talk to the Committee about the recent successful bid for the out of hours service in Hackney that had been tendered for successfully by a consortium of Hackney GP’s

Sue Richards of Keep Our NHS Public campaign was also present.

Dr. Davies made a presentation to the Committee, a copy of which is interleaved, and during discussion of the presentation the following main points were made –

·         Following the takeover of the GP Out of Hours service by Care UK in 2012  and in April 2013 LCW, not for profit, commenced contract to provide 111 for C&I

·         2013 October: Primary Care Foundation review of Harmoni/Care UK Out of Hours service. The review found the service was clinically safe and provided good care

·         2014 March: Urgent Care Review Camden and Islington

·         There had been community engagement on the urgent care review

·         The community wanted smooth and efficient links between NHS 111 and the OOH and a service that is easy and accessible, staff operating NHS 111 have the right knowledge and skills, easy referral into the necessary services, everyone in the community will find the service easy to use and more local knowledge of NHS 111 and OOH

·         The urgent review conclusions recommend that the 111 service is commissioned across all North Central London and a combined NHS 111, GP Out of Hours service as a single whole system model, but not necessarily a single provider

·         The features of the new re-procurement include – NHS 111 across five boroughs, as now, NHS 111 and GP out of hours services integrated although not necessarily under a single provider for both services, NHS 111 in line with the nationally mandated model, with local influence where possible and with GP out of hours services still providing telephone support, face to face visits, and home visits

·         NHS England require a robust re-procurement process, with evidence

·         Primary care will see significant other changes in the next 1-5 years

·         Flexibility will be built into the new model to ensure that the service can be adapted to further change

·         Related primary care developments include the funding of additional capacity in general practice- 65 additional hours per week pan Islington from2014/15, Pan Islington service under development intended to provide general practice 8 – 8, 7 days per week

·         Angel Medical services contract renewed – 7 day extended access to GP appointments and agreement from all practices to develop pan Islington federation

·         What is possible – one governance structure, improved response by joining NHS 111 and GP out of hours service, prescriptions via pharmacist available  ...  view the full minutes text for item 77.

Simon Knight and Jonathan Fielden were present for discussion of this item and made a presentation to the Committee, a copy of which is interleaved. Apologies were given for Fiona McKenzie, Governor at UCLH who could not be in attendance that evening as she was unwell.

During the presentation the following main points were made –

·         Key strategic priorities for providing specialist care are cancer, neurosciences, women’s health with a strong and high quality foundation in acute and emergency medicine, surgery and critical care

·         Clinical priorities for 2015/16 are to reduce hospital acquired pressure ulcers, reduce cases of sepsis, reduce cardiac arrests/cases where there has been no detection of deterioration in the patient’s condition, reduce medication errors, reduce hospital acquired infections and develop speciality outcome measures

·         In patient satisfaction was 81.6% and patient feedback was gathered through the annual national survey and friends and families scheme either on line or in paper format. Multiple methods of collecting information were used and these were being constantly developed

·         Accident and Emergency access times were above the London average however due to the proximity of UCLH this tended to attract users who were not residents of the area, predominantly the 20-40 year old age group

·         There was a 9 phase building programme for improving ambulatory care that would take until 2018 to complete. Medical record keeping had been improved and regularly checked and the system was moving over to electronic record keeping

·         There were significant  financial challenges which has led to a savings requirement of between £20 and £45 million each year for the past 6 years and 2015/16 will require at least the upper end of that range. Cost improvement programmes had been implemented and these are challenged for safety and clinical purposes to ensure quality of care. UCLH is strongly clinically led and this assists in this process

·         Transformation systems are in place to deliver improved staff/patient experience

·         UCLH has a strong focus on working closely with local CCG’s and Councils to avoid unnecessary admissions to hospital and is redesigning services to focus on prevention care in community settings

·         The maternity service is expanding and new capacity is planned to increase births from 6000 to 8000 per annum

·         Reference was made to the fact that UCLH had a good reputation with regard to cancer care and enquired what outreach work was taking place. It was stated that UCLH were trying to get patients to present earlier and they were working with other hospitals and other organisations to obtain a smoother pathway to treatment and reduce waiting times

·         Discussion took place as to the waiting time for prostate cancer and it was stated that 60% of patients were seen within 62 days, however this is sometimes due to patients wanting time to come to terms with having treatment

·         In response to a question it was stated that there was working group looking at urgent care models and work was going on with both Islington and Camden in order to reduce Accident and  ...  view the full minutes text for item 78.

Nick Mann – GP Hackney

Healthwatch

Islington CCG

The Chair introduced Valerie White, a resident who gave evidence in relation to concerns over the treatment she had received and the complaints process.

Martin Machray, Islington CCG, was present and outlined the report.

During consideration of the report and the patient evidence the following main points were made –

·         It was difficult to get a consensus view from patients on issues

·         There were two types of patient feedback, passive feedback where a response is awaited and active feedback where responses are actively sought by going out to patients and asking them. Both types of feedback should be sought

·         The Chair stated that there was a need to ensure that patient feedback was actually taking place and that methods used to collect this information were effective. He referred to the methods of patient feedback referred to in the presentation by UCLH and obtaining feedback before patients left the hospital

·         Members were informed of the problem Ms.White had had with regard to dental problems that she had and with the complaints process that only had been resolved with the assistance of Healthwatch and there had been a general lack of co-ordination within the system regarding her treatment. The view was expressed that these problems would have been exacerbated if the person had mental health problems, disability problems or a learning disability

·         During discussion it was stated that the PALS service offered patients a route to complain however often the Trust would try to resolve complaints in the first instance by engagement with front line staff

·         It was stated that Moorfields had provided patients with a text facility if they were not happy with the treatment or service that they were receiving and a member of staff would come to see them, however they had informed the Committee that this had not been used by patients

·         Members were of the view that whilst the information contained in the report was useful there was the need to investigate what types of patient feedback were currently being used by GP’s and Trusts serving Islington residents. Martin Machray stated that there was information available and he would discuss with the Chair following the meeting the type of information to be provided to the next meeting

·         A Member stated that patient participation groups were often held at inconvenient times for working residents and this discouraged feedback for a large percentage of people

The Chair thanked Valerie White and Martin Machray for attending

Clare Henderson and Simon Galczynski, Housing and Adult Social Services were present for discussion of this item and outlined the report.

During consideration of the report the following main points were made –

·         The Better Care Fund is aimed at supporting integrated care across health and social care. The Council and Islington CCG worked jointly to develop plans to support the work of the integrated care programme, support the continued investment in social care services that benefit health and to support the changes in social care as a result of the Care Act, for example, a new statutory duty to assess the needs of carers

·         The BCF was signed off by the local Health and Wellbeing Board in September 2014 and NHS England signed it off with support, which meant that the CCG is required to provide assurance to NHS England through its regular reviews that are being delivered on the key outcomes and that the partnership is working effectively

·         A Member referred to BCF 12 and the allocation of £415k to support carers and it was stated that this funding would remain in the pooled budget and any additional requirements of carers were being scoped out. Islington personal budgets were generous and carers assessments were provided

·         It was stated that models were being developed and there were additional numbers of carers coming forward and this funding, together with additional funding from the Government would be available and these figures could be provided to Members if required

·         Members were informed that attempts were being made to shift resources away from hospital to community services and work was being carried out on an integrated care programme to work with GP’s to support patients in navigating the system, however there was no new funding for this work

·         Work was being undertaken to develop a personal health offer for social care management

·         Resources were stretched both within the Council, NHS and voluntary sector and work was taking place to see how the sectors could best work in partnership

·         In response to a question as to eligibility criteria it was stated that Islington retained provision for moderate needs

·         It was stated that additional funding was being provided to fulfil obligations under the Care Act and that funding provided should be sufficient, however there would be challenges in 3 years time when the care cap is implemented

·         It would be important in future to ensure that the pace of change was managed over a short period of time and work was being carried out to ensure that integrated care was successful but the scheme was still in it’s infancy and there was limited evidence to date to assess whether it was working effectively

·         It was noted that the Care Act placed additional responsibilities on Local Authorities

RESOLVED:

That the joint work that Islington is doing to develop integrated care for local people be noted